Every human is a sexual being. Patients need confidence in talking to both their partner and their healthcare provider about sexual concerns. Sexual dysfunction is frequently one of the first manifestations of physical illness, but is often not inquired about on routine review of systems.1 For example, a rheumatology review of systems allows for the unique ability to inquire about potentially sensitive issues such as vaginal dryness or pelvic girdle mobility. Yet sexual concerns are generally overlooked.
Case #1: Martha
As a rheumatology healthcare provider myself, I was caught off guard by a patient. During the end of a routine encounter with a 54-year-old patient with ankylosing spondylitis, Martha said she had one last question.
“I am having trouble opening my legs wide enough to have intercourse with my husband,” she said. Martha admitted that her disease state was affecting her ability to respond sexually and comfortably to her husband in the way to which she was accustomed.
I looked at her quizzically and paused. She said, “Oh, I have embarrassed you, I am sorry.” I looked at her and shook my head, replying, “You didn’t embarrass me; I just don’t know the answer to your problem.”
Over the course of her disease, Martha’s sacroiliac joints had fused. This common phenomenon in ankylosing spondylitis was the root of her problem. Later that week, I spoke to an osteopathic physician from Michigan State University who specialized in osteopathic manipulative medicine (OMM). He agreed to treat her.
At her three-month checkup, Martha had improved her pelvic range of motion and had resumed intercourse with less restriction. She understood that it would require an adherence to exercise and compliance with her medication to maintain her flexibility.
Martha’s dilemma made me wonder how rheumatologic diseases affect intimacy. The more I read, the more I realized that every single chronic illness can change a person’s role in his or her relationship and can, if not treated, adversely affect his or her sexual health. Rheumatology healthcare providers have the unique opportunity to counsel patients who suffer from chronic pain and myriad physical limitations that can have profound effects on intimacy.
It has been estimated that about two-thirds of people with hip osteoarthritis (OA) and a similar number of women with rheumatoid arthritis (RA) experience sexual dysfunction. Nearly one-fifth of respondents to a survey about arthritis and sexuality said they were unable to engage in sexual intercourse due to limitations from arthritis.2